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OVERVIEW OF ANEMIA TREATMENT IN NON-DIALYSIS CHRONIC KIDNEY DISEASE
INGRID PRKAČIN
orcid.org/0000-0002-5830-7131
; Merkur University Hospital, Department of Internal Medicine, Zagreb, University of Zagreb, School of Medicine, Zagreb, Croatia
MARKO MARTINOVIĆ
; Merkur University Hospital, Department of Internal Medicine, Zagreb, Croatia
JOSIP HRABAR
; Merkur University Hospital, Department of Internal Medicine, Zagreb, Croatia
DOMAGOJ MARKOVIĆ
; Split University Hospital Centre, School of Medicine, Department of Internal Medicine, Split, Croatia
DOMINIK RAOS
; Institute for Emergency Medicine of Zagreb County, Zagreb, Croatia
INGA MANDAC ROGULJ
; Merkur University Hospital, Department of Internal Medicine, Zagreb, University of Zagreb, School of Medicine, Zagreb, Croatia
Abstract
Erythropoiesis-stimulating agents (ESAs) administered either subcutaneously (sc.) or intravenously (iv.), along with iv. or oral iron therapy, are currently the cornerstones for treating anemia in patients with chronic kidney disease (CKD). Multiple factors are involved in the pathogenesis of anemia in CKD: iron deficiency, inadequate production of erythropoietin (Epo), hepcidin and hypoxia-inducible factors (HIFs). Patients with CKD are prone to iron deficiency (absolute and functional). In this study, we compared the efficacy and safety profile of oral and intravenous iron with erythropoietin beta (subcutaneously in a dose of 4000-6000 IU every week) for the treatment of iron deficiency anemia in 43 non dialysis patients (ND-CKD) with the confirmed diagnosis of iron deficiency anemia (A) at Merkur University Hospital. Exclusion criteria were patients on dialysis or transplantation, with heart failure, secondary hyperparathyroidism, malignancy, thromboembolism, gastrointestinal bleeding, hsCRP >5 mg/L, patients taking medicines that suppress Epo production, and uncontrolled resistant hypertension. Patients were divided into groups on intravenous iron in doses of 1000 mg every month and oral daily intake of iron (ferrous fumarate 350 mg). Iron supplementation was administrated in order to achieve serum ferritin 200-500 mg/L. Hemoglobin (Hb) was checked at the beginning and after 12 months in both groups. Paired sample t-test was applied for comparison of results. The mean level of iron at the beginning in M/F was 9.7/7.9±0.28/0.31 and after 12 months 10.7/8.94±0.27/0.43 μmol/L. In the treatment groups, the mean Hb level was 9.19±0.84 g/dL (A) and 9.72±0.95 g/ dL (B). The mean increase in Hb was 10.65±0.97 g/dL (A) and 10.42±1.22 g/dL (B) at 12 months (p<0.001, if we compare Hb levels before and after 12 months of iron therapy). There were no statistically significant differences in Hb increase between groups A and B. Parenteral or oral iron in combination with Epo is effective treatment of anemia in ND-CKD patients if other factors are considered. In patients with recognized other causes of resistance to ESAs, new drugs such as hepcidin antagonists, HIF and ferroportin stabilizers will delay CKD progression. This alternative therapeutic approach in the future may avoid the overshoots and fluctuations in Hb levels seen with currently injectable ESAs and provide a steady and controlled rise in Hb concentration.
Keywords
anemia; chronic kidney disease; predialysis
Hrčak ID:
229940
URI
Publication date:
5.12.2019.
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